Medicine: Rheum Flashcards
1
Q
What are the key parts to a rheum hx?
A
PC - joint pain, stiffness, swelling
SHx - functionality, job, driver, smoking, drug compliance
SRV - skin, eyes, renal, constitutional, fatigue
2
Q
What does the timing of the stiffness indicate?
A
Early morning, within ~half an hr, inflammatory
Worsens throughout the day infers more degenerative
3
Q
What is the DAS28?
A
Disease Activity Score - 28 Joints
Number swollen and tender, inflam marker, global assessment
4
Q
How does the DAS28 score translate to disease activity?
A
> 5.1 Active
<3.2 Low
<2.6 Remission
5
Q
Which is arguably the most important aspect of rheum exams?
A
Looking
6
Q
Talk through the hand exam
A
LOOK
Elbows, hands, skin, nails, palms, finger pulps
FEEL
Pulses, muscle bulk, snuffbox, tendon thickening, sensation, temp, squeeze MCPs then individually each MCP PIP DIP and wrists, sensation
MOVE
Active prayer and reverse, passive wrist flexion/extension, extend fingers, splay, push hands down, thumb, fists
FUNCTION
Power grip, pincer grip, pick up small object/do up button/hold pen, Tinel’s, Phalen’s, Froment’s, Finkelstein’s
7
Q
What are you looking for in the elbows?
A
Psoriatic plaques, rheumatoid nodules, olecranon bursa, gout tophi
8
Q
Where else should you look if you’re suspicious of gout?
A
The pinna of the ear
9
Q
What are your looking for in the hands?
A
Hands: swelling, loss of alignment, muscle wasting, scars, symmetry
Skin/nails: pitting, ridging, nail fold vasculitis
Palms/finger pulps: palmar erythema and scars from carpal tunnel release
10
Q
Boutonniere deformity @ PIP and DIP
A
Flexion @ PIP
Extension @ DIP
11
Q
Swan neck deformity @ PIP and DIP
A
Extension @ PIP
Flexion @ DIP
12
Q
What do nail signs suggest?
A
Clubbing - cardio, resp, gastro
Pitting - psoriasis
Koilinychia - iron def
Leukonychia - liver disease
Splinters - vasculitis
13
Q
How do you test sensation in the hands?
A
Median - over thenar eminence
Ulnar - over hypothenar eminence
Radial - thumb and index webspace
Plus can do C678 dermatomes
14
Q
Describe Phalen’s test
A
If you suspect carpal tunnel, perform reverse prayer for 60s or squeeze wrist and force into flexion for 30s, pos if any tingling/numbness
15
Q
SEs of colchicine
A
Nausea, vomiting, diarrhoea
16
Q
Which three qs do you always ask at the start of the GALS screen?
A
Pain and stiffness, dressing, stairs
- Do you have any pain or stiffness in your muscles, joints or back?
- Can you dress yourself completely w/o any difficulty?
- Can you walk up and down the stairs w/o any difficulty?
17
Q
GALS: What are you looking for in the gait?
A
Smoothness, symmetry, ability to turn quickly
NB: heal to toe and tip toe walking is more neuro looking for cerebellum problems
18
Q
GALS: What are you looking for during inspection?
-From Behind-
A
Trapezius and gluteal muscle bulk size and symmetry
Spinal alignment
Level iliac crests
Popliteal obv swelling
Hindfoot abnormalities
19
Q
GALS: What are you looking for in the spine?
-From Side-
A
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Schober’s test
Knee flexion/hyperextension
20
Q
What does Schober’s test assess?
A
Lumbar flexion by placing two fingers on adjacent vertebrae and asking the pt to touch their toes and come back up again
21
Q
GALS: What are you looking for in the arms?
-From Front-
A
Muscle bulk and symmetry
Elbow extension in anatomical position
Cervical spine lateral flexion each side
Open jaw wide and move side to side
Elbow flexion w hands behind head
Crude hand exam inc fists, thumb to each finger, power grip and squeeze across MCPs
22
Q
What is TMJ pain often a/w?
A
RA and inflam joint disease
23
Q
What else does putting hands behind head w elbow back test?
A
Humeral movement and functionality
24
Q
GALS: What are you looking for in the legs?
-Lying Down-
A
Passive knee flexion, hip flexion, hip internal rotation
Patellar tap looking for a large effusion
Sweep/bulge test looking for smaller effusions
Crude foot exam inc callus formation and squeeze across MTPs
25
Which rotation at the hip do you perform as part of the GALS screen?
Internal
26
How do you record an unremarkable GALS in the notes?
GALS: NAD
27
What does REMS stand for?
Regional Examination of the Musculoskeletal System
28
Hx for Ank Spond
Fatigue, lower back stiffness > pain, early morning and after sitting then relieved by activity
Plus quick SRV
29
What should you do if you lose your thought in a hx?
Summarise
30
Ix for Ank Spond
Bloods inc HLA-B27, xray, MRI
31
What would you find on MRI of ank spond?
Sacroiliitis
32
Mx for Ank Spond
Early intervention w physio and NSAIDs then consider steroids and biologicals
33
What is the ACR and EULAR 2010 RA diagnostic cut off?
6 points to dx RA & <6 labelled as undifferentiated inflammatory arthritis
34
Outline the rheumatoid arthritis ACR and EULAR 2010 classification criteria
Tbc
35
Felty’s Triad
RA, Splenomegaly, Neutropenia
36
Hand Hx
Hand dominance, weakness, tingling, pregnant, rheumatoid, prev surgery
37
RFs for Gout
```
Age
Male
Injury
CVD
HTN
CKD
Diabetes
Obesity
Thiazide
Lead
FHx
Diet
Alcohol
```
38
Mx of Gout vs Pseudogout
Bloods: FBC, U+Es, Uric Acid
Acute Tx: NSAIDs, Colchicine, Steroids
Chronic Tx: lose wt, inc water dec alcoholic and fizzy drinks, low purine diet + allopurinol w initial NSAID cover if gout>pseudo
39
How can SLE be diagnosed?
>=4
Serositis
Oral Ulcer
Arthritis
Photosensitivity
```
Blood Disorder
Renal Disorder
Anti Nuclear Abs
Immuno Disorder
Neuro Disorder
```
Malar Rash
Discoid Rash
40
What is Hatchet sign?
The limited erosion of the lateral aspect of the humeral head found in ank spond
41
What do the lumbricals of the hands do?
Flex at MCP + Extend at IPJ
42
Which inflammatory conditions are more common in males>females? (2)
PSC + Ank Spond
43
What do OA hands look like?
Heberden’s @ DIP
Bouchard’s @ PIP
Base of Thumb Squaring
44
Psoriatic Arthritis
Psoriasis
Nail Changes: onycholysis, pitting, subungual hyperkeratosis, discolouration
Small joint arthritis involving both the PIP and DIP joints
Dactylitis
45
Which antibody is most specific for RA?
Anti-CCP
46
Ix for RA
O/e: tender, stiff, swollen, number and type of joint involved, DIP sparing
Bloods: acute phase markers, anti-CCP, rheumatoid factor
Imaging: early disease may show synovitis on US/MRI but x-rays monitor joint damage over time - loss of joint space, bony erosions, periarticular osteopenia, joint deformities
47
Mx of RA
1. Analgesics
2. NSAIDS
3. Steroids
4. DMARDs - conventional (methotrexate), biological (anti-TNF), targeted (JAK inhibitors)
Conventional:
Methotrexate
Sulphasalazine
Hydroxychloroquine
```
Biological:
Anti-TNF
IL-6 Receptor - toclizumab, sarilumab
Anti-CD20 (target B cells) - rituximab
CTLA4-Ig (targets T cell activation) - abatacept
```
Targeted:
JAK Inhibitors
48
Anti-TNF
```
Etanercept
Adalimumab
Certolizumab
Golimumab
Infliximab
```
49
JAK Inhibitors
Tofacitinib
Baricitinib
Upadacitinib
Filgotinib
50
What is characteristic of the spondyloarthritides?
```
HLA B27
Arthritis
Sacroiliitis
Iritis
Dactylitis
Enthesitis
```
51
What is the ASAS classification of axial spondyloarthritis?
Aged <45 w at least 3mnths of back pain
Must have sacroiliitis on imaging plus one other feature or HLA B27 plus two other features
52
What drug won’t work for axial spondyloarthritis?
Conventional DMARDs
53
Mx of Ank Spond
1. Analgesics
2. NSAIDS
3. DMARDs - biological (anti-TNF and IL-17 blocker) + targeted (JAK inhibitors)
54
What is the ASAS classification of peripheral spondyloarthritis?
Aged <45 w peripheral features only
Must have arthritis/enthesitis/dactylitis plus one/two other features
55
Psoriatic Arthritis X-ray
Loss of joint space
Erosions
Bony proliferation
Osteolysis
Spurs
56
Mx of Psoriatic Arthritis
1. Analgesics
2. NSAIDS
3. DMARDs - conventional (methotrexate), biological (anti-TNFα or anti-IL17), targeted (JAK inhibitor or apremilast)
57
Which organisms cause reactive arthritis?
GU: chlamydia
GI: shigella, salmonella, yersinia, campylobacter, e coli
58
SLE
Mild: rash, arthritis, lymphadenopathy
Mod: pleurisy, pericarditis, cytopenia
Sev: renal and CNS involvement
59
What are the SLICC criteria for diagnosing SLE?
Must have biopsy proven lupus nephritis w positive ANA or dsDNA
OR
Must have four criteria including at least one clinical and one immunological
60
Mx of SLE
Minimise the use of prednisolone and add steroid sparing agents: hydroxychloroquine for skin and joint involvement, azathioprine, mycophenolate, rituximab, tacrolimus, cyclophosphamide for sev disease
61
Ix of CTD
Screen with ANA then dsDNA, ENA, cytoplasmic to confirm dx
62
How do you monitor treatment efficacy in SLE?
ESR
dsDNA
C3/C4
63
Primary Sjogren’s Syndrome
It involves inflam destruction of exocrine glands particularly the lacrimal and salivary
64
What should you counsel a young female with anti-Ro or anti-La abs about?
If she does get pregnant they can cross the placenta and cause fetal heart block
65
Where does the skin involvement in CREST not progress beyond?
Forearms/Calves
66
Comps of LCSS
Pulmonary HTN
Plus: ILD, renal crisis, extensive gut disease (all more common in DCSS)
67
Ix for Scleroderma
Dx: ANA, anti-centromere for LCSS, anti-scl70 for DCSS
Comps: ECG/echo, CXR/CT, U+Es/urinalysis
68
Mx of Raynaud’s
Consrv: avoid cold environments, keep whole body warm, gloves
Medical: nifedipine, sildenafil, IV iloprost
69
Ix for Dermatomyositis
```
CK
ANA
Myositis Ab Panel
MRI Involved Muscle
Electromyogram
Muscle Biopsy
```
70
Ix for GCA
Acute Inflam Markers
Temporal Artery US +/- Biopsy
FDG PET Scan
71
Mx of GCA
Immediate PO Prednisolone 40-60mg 4w + urgent ophthal review
If visual sx: add IV methylprednisolone 500mg
If persistent/relapsing disease: add an IL6 blocker
72
ANCA
cANCA: a/w abs to proteinase 3 occurring in pts w GPA
pANCA: a/w abs to myeloperoxidase occurring in pts w eGPA and microscopic polyangiitis
73
Ddx of Purpuric Rash
Infection: meningococcal septicaemia + haemorrhagic fevers
Inflammation: HSP
Thrombocytopenia: ITP
74
What could you give pts who are unable to tolerate wkly alendronate?
Annual IV Zoledronate
OR
Biannual S/C Denosumab
75
How many wks after an acute attack of gout should you wait before starting allopurinol?
3wks
76
What are the RFs for CPPD?
Inc Age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia
77
What is the typical pt w PMR?
Elderly pt w bilateral morning stiffness in shoulder and hip girdles + pain - weakness but pain makes raising arms, getting out of a chair and going up the stairs difficult
78
Ix for PMR
Raised ESR/CRP
Plus rule out ddx: RA - anti-CCP; Myositis - CK; Malignancy - FLAWS, bloods, serum electrophoresis, urinary bence jones protein, CT CAP
79
Mx of PMR
Start prednisolone 15mg/d PO and expect a dramatic response within 1wk then wean 1mg/mnth
80
What is the most specific antibody for SLE?
Anti-Smith
| Anti-dsDNA
81
Tx of Raynaud’s Syndrome
```
Nifedipine
Primrose Oil
Sildenafil
Epoprostenol
Sympathectomy
```
82
What ab is a/w drug-induced SLE?
Antihistone
83
What should be performed annually in pts w diffuse systemic sclerosis? (2)
Echo + Spirometry
84
What ab is a/w mixed CTD?
Anti-U1-RNP
85
Which NSAID carries the lowest cardiovascular risk?
Naproxen
86
Ix for Myositis
Inc muscle enzymes in plasma ie ALT AST LDH CK and aldolase; EMG shows fibrillation potentials; MRI shows oedema if acute; autoabs anti-M2 and anti-Jo1 if acute and ILD; muscle biopsy confirms the dx
87
Tx of Myositis
Prednisolone
If resistant: immunosuppressives/cytotoxics
If skin disease: hydroxychloroquine/topical tacrolimus
88
Ddx of DIP Involvement
OA + Psoriatic Arthritis
89
What are the three best tests for monitoring activity in SLE?
Anti-dsDNA
Complement
ESR
90
Which DMARD causes azoospermia?
Sulfasalazine
91
Which DMARD causes retinopathy?
Hydroxychloroquine
92
Why may a pt w polymyalgia rheumatica appear weak?
Pain inhibition > true weakness of limb girdles
93
What are the Gell and Coombs classification of hypersensitivity?
I - Anaphylactic IgE
II - Cell Bound IgG/M
III - Immune Complex
IV - Delayed T Cell
94
What is the defect in Marfan’s syndrome?
FBN1 gene, chr15, fibrillin-1
95
What might dilation of the aortic sinuses lead to?
Aortic Aneurysm
96
What cardiac features can be found in Marfans pts?
Aortic aneurysm, dissection, regurg + mitral valve prolpase therefore require annual echo +/- meds
97
Inf MI + complete heart block tx
Consrv is asx and haem stable or w atropine if also chest pain, syncope, HF or shock
98
Ant MI + complete heart block tx
Pacing
99
Ix to rule out and confirm dx of SLE
Rule out: ANA has the highest sensitivity
Confirm dx: anti-dsDNA has the highest specificity
100
What should be screened for following dx of dermatomyositis?
Underlying malignancy typically ovarian, breast, lung
101
What are the skin features of dermatomyositis?
Photosensitive, heliotrope rash in periorbital region, Gottrons papules over dorsum of hands
102
cANCA vs pANCA
cANCA: targets PR3 + pos for GPA
pANCA: targets MPO + pos for eGPA, microscopic polyangiitis, UC/PSC
103
Mx of ANCA associated vasculitis
MDT: rheum, resp, renal
104
Ix + Mx for GCA
Ix: inflam markers + temporal artery biopsy
Tx: high dose pred + urgent same day ophthal review
105
Typical demographic of ank spond pt
Young Male
106
Ix + Mx for Ank Spond
Ix: inflam markers and HLA-B27, spirometry, imaging
Mx: encourage reg exercise, physio, NSAIDs, DMARDs if peripheral joint involvement, anti-TNF if persistently high disease activity despite conventional tx
107
What does the x-ray of sacroiliac joints show in ank spond pts?
May be normal early in disease
Sacroiliitis, sclerosis, subchondral erosions
Plus squaring of lumbar vertebrae, syndesmophytes, bamboo spine (late and uncommon)
108
What does MRI show in ank spond pts?
Done if neg x-ray but still high suspicion which will show signs of early inflam eg BM oedema
109
What is the dagger sign of a bamboo spine?
Single central radiodense line on x-ray related to ossification of supraspinous and interspinous ligaments
110
What causes syndesmophytes?
Ossification of outer fibres of annulus fibrosus
111
How long should either sex wait following methotrexate tx before conceiving?
6mnths
112
How often is methotrexate taken?
Wkly
113
What should be co-prescribed alongside methotrexate and when should it be take?
Once wkly folic acid 5mg taken >24hrs after each methotrexate dose
114
Which pts <60yrs get pseudogout?
Underlying risk factor: haemochromatosis, Wilson’s disease, acromegaly, hyperparathyroidism, low Mg, low phosphate
115
What is antisynthetase syndrome?
A subtype of dermatomyositis: myositis + ILD +/- hand sx
116
Which abs are pos in antisynthetase syndrome?
Anti-Jo1
117
What are the bone profile blood tests results in pts w osteogenesis imperfecta?
Normal: Ca, PO4, PTH, ALP
118
What does hyperCa in the absence of elevated PTH suggest?
1° Malignancy or Sarcoidosis
119
What hx is suggestive of acute reactive arthritis?
Can’t see, pee or bend the knee
120
Def of reactive arthritis + most commonly associated organisms
Arthritis following an infection where the organism cannot be recovered from the joint
Post-Dysenteric: shigella, salmonella, yersinia, campylobacter - M=F
Post-STI: chlamydia trachomatis - M>F
121
How do renal comps of systemic sclerosis px + tx?
HTN + AKI +/- MAHA -> ACEi
122
What is labetalol commonly used for?
To acutely lower BP in haemorrhagic strokes
123
Preventing pathological fractures: bisphosphonates vs denosumab
Whilst alendronate is first line if eGFR <30 then denosumab is preferred
124
Denosumab: Dose + SEs
Dose: S/C 60mg 6mnthly or 120mg 4wkly to prevent skeletal-related events in adults w mets from solid tumours
SEs: dyspnoea + diarrhoea
125
What markers are used to monitor SLE flares? (2)
Dec Complement + Inc ESR
126
How does anti-phospholipid syndrome px?
CLOTS: clots, livedo reticularis, obstetric comps, thrombocytopenia
127
What is the mx for antiphospholipid syndrome?
Based on EULAR guidelines: low dose aspirin or lifelong warfarin following a VTE
128
What does antiphospholipid syndrome cause a paradoxical rise of?
APTT
129
What are the blood results for polymyalgia rheumatica?
Raised WCC/CRP/ESR + Normal CK
130
Mx of Gout
Acute: any CIs? NSAIDs, colchicine, pred, continue the allopurinol throughout if already taking
Chronic: started 2wks after initial attack (1) Allopurinol (2) Febuxostat
Lifestyle Mods: lose weight, red high purine foods/alcohol, stop precipitating drugs
131
Which drugs classically cause drug induced lupus? (3)
Procainamide (antiarrhythmic), Hydralazine (tx high BP), Isoniazid (anti-TB)
132
How does drug induced lupus typically px?
Arthralgia, Myalgia, Skin/Pulmonary Involvement
133
Which abs are a/w drug induced lupus?
Antihistone
134
SLE vs DIL
SLE: young + female
DIL: elderly + male
135
What is the adverse effect of hydroxychloroquine?
Bulls eye retinopathy which may result in visual loss, baseline ophthal exam, annual screening
136
Mx of OA
Consv: wt loss, encourage exercise, local muscle strengthening, braces, insoles
Medical: para and topical NSAIDs if knee/hand, oral NSAIDs w PPI, opioids, capsaicin cream, steroid injections
Surg: if above fail refer for joint replacement
137
Cardiac comps of Ehler-Danlos syndrome (3)
Aortic regurg, mitral valve prolapse, aortic dissection
138
When should sulfasalazine be avoided? (2)
G6PD def + allergy to aspirin or sulphonamide
139
Do you stop the pred if clinical suspicion of GCA but temporal biopsy is neg ?
No because skip lesions mean the result may show up as neg
140
What does systemic vasc sx + hep B signs - pulm signs suggest?
Polyarteritis Nodosa
141
What are the features of poor prognosis in RA? (7)
Insidious onset, poor functional status at px, extra articular features, erosions on x-ray <2yrs, HLA DR4, RF, anti-CCP abs
142
Outline bone protection for pts starting steroids >65yo / prev fragility # / will be >3mnths / DEXA >-1.5
Co-prescribe alendronate, calcium, vit D replete
143
Outline bone protection for pts starting steroids <65yo
Offer bone density scan w T score: >0 reassure + 0 to -1.5 repeat scan in 1-3yrs
144
What is the initial mx of RA?
DMARD monotherapy +/- short course of bridging prednisolone
145
What does hyperPTH put you at an inc risk of developing? (2)
Pseudogout + Renal Stones
146
What is the relationship b/w calcium and eye problems?
HypoCa - Cataracts
HyperCa - Corneal Calcification
147
Frozen Shoulder vs Polymyalgia Rheumatica
FS: unilateral + pain then stiffness
PR: bilateral + both sx together
148
Limited cutaneous systemic sclerosis abs
Anti-centromere abs
149
Diffuse cutaneous systemic sclerosis abs
Anti-Scl-70 abs
150
What are the 8A’s of ank spond?
```
Anterior Uveitis
Apical Fibrosis
Aortic Regurg
AV Node Block
Amyloidosis
Achilles Tendonitis
Arthritis Peripherally
And Cauda Equina Syndrome
```
151
What are the clinical findings of ank spond?
Posture: loss of lumbar lordosis + accentuated thoracic kyphosis
Examination: red lateral flexion, forward flexion, chest expansion
152
How is forward flexion tested?
Schober’s Test: a line is drawn 10cm above and 5cm below dimples of Venus and it should inc >5cm
153
What are the crystals from joint aspiration like in gout, pseudogout, RA and OA?
Gout: monosodium urate, needle shaped, neg birefringent
Pseudo: ca pyrophosphate, rhomboid shaped, pos birefringent
RA: cholesterol, rhomboid shaped, neg birefringent
OA: ca phosphate, coffin lid shaped, no birefringence
154
What is first line mx for ank spond?
Physio + NSAIDs
155
What are the adverse effects of bisphosphonates? (5)
Acute phase response, oesophageal reactions, osteonecrosis of jaw, inc risk atypical stress #, hypoCa
156
What are the adverse effects esp w alendronate? (2)
Oesophageal ulcers + inc risk of atypical stress # of proximal femoral shaft
157
How should oral bisphosphonates be taken?
Taken on empty stomach >30mins before breakfast or another oral med + then remain sat/stood in that time
158
What do the bloods show in antiphospholipid syndrome?
Raised APTT, Normal PT, Thrombocytopenia
159
What is the main immunoglobulin found in breast milk?
IgA
160
What does low Ca and PO4 w raised ALP make you think of?
Osteomalacia
161
What are the possible eye signs of Marfan’s syndrome? (3)
Upwards lens dislocation, blue sclera, myopia
162
Do Marfan’s pts have learning difficulties?
No
163
What are chemo pts at an inc risk of?
Gout
164
Mx of Pseudogout
Aspiration of joint to exclude septic arthritis + then NSAIDs, colchicine, steroids
165
What are the adverse effects of sulfasalazine? (5)
Oligospermia, SJS, may colour tears
Plus resp: pneumonitis + fibrosis
Plus haem: myelosuppression, Heinz body anaemia, megaloblastic anaemia
166
Is sulfasalazine safe in preg + breastfeeding?
Yes
167
What should be checked before starting azathioprine? (2)
If the pt is on allopurinol + a TPMT test to assess risk of toxicity
168
What are the adverse effects of azathioprine? (4)
N+V, pancreatitis, BM depression, inc risk of non-melanoma skin cancer
169
Is azathioprine safe in preg + breastfeeding?
Yes in preg but use cautiously if breastfeeding
170
What does arthritis w nail and skin changes suggest?
Psoriatic Arthropathy
171
Which hand joint is predominantly affected in psoriatic arthropathy?
DIPs
172
What deformity is classically a/w psoriatic arthropathy?
‘Pencil-in-cup’
173
Ddx for HyperCa (3)
If high PTH: 1° or 3° hyperparathyroidism
If low PTH: malignancy, XS calcium/vit D, paget’s, thyrotoxicosis, adrenal insufficiency
Plus drug SEs: thiazide diuretics, lithium, vit A
174
How many NSAIDs must have failed before starting anti-TNFα inhibitor for ank spond?
Two + meets criteria for active disease on two occasions 12wks apart
175
Why colchicine>NSAIDs in elderly pt on warfarin w gout?
Risk of life threatening GI haemorrhage
176
Which score is useful for assessing hypermobility?
Beighton
177
What is used to tx acute flares of RA?
IM Steroids
178
What does the presence of chondrocalcinosis on x-ray point you towards?
Pseudogout > Gout
179
What is the z-score adjusted for?
Age, Gender, Ethnicity
180
What is the classic triad of Behcet’s syndrome?
Oral ulcers, genital ulcers, ant uveitis
181
What is the HLA association w Behcet’s?
HLA B51
182
What are the four spondyloarthropathies?
PEAR: psoriatic, enteropathic, ank spond, reactive
183
Would you find the organism in a joint aspirate of reactive arthritis?
No only in a septic joint
184
How regularly is methotrexate taken?
Wkly
185
What should be co prescribed alongside methotrexate?
Wkly Folic Acid 5mg
186
What interacts w methotrexate? (2)
High dose aspirin inc risk of toxicity by red excretion + trimethoprim inc risk of marrow aplasia
187
What clinical feature is most specific for inflammatory back pain?
Improvement w activity and not relieved by rest
188
What is caused by compression of the lateral cutaneous nerve of the thigh?
Meralgia Paraesthetica
189
What should you screen for before starting biologics?
TB, Hep B/C, HIV
190
What are the most commonly implicated bacteria preceding reactive arthritis?
Chlamydia Trachomatis
Salmonella Enterica
Campylobacter Jejuni
